Healthcare Provider Details

I. General information

NPI: 1942306253
Provider Name (Legal Business Name): JEFFREY MCKINLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 CALDWELL ST
MCMINNVILLE TN
37110-2032
US

IV. Provider business mailing address

358 CALDWELL ST
MCMINNVILLE TN
37110-2032
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-2355
  • Fax:
Mailing address:
  • Phone: 931-473-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC717
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: